Mitral valve (MV) repair is the preferred treatment in patients with MV insufficiency. The unsolved problem in MV repair surgery is predicting which repair is optimal for each patient. Much of the difficulty lies in not precisely understanding MV physiology which predisposes it to dysfunction and insufficiency. If imaging techniques can be combined with appropriate computational MV evaluation methods, then improved diagnosis and therapeutic approaches to MV repair can be developed. Current clinical three-dimensional (3-D) echocardiography can demonstrate excellent volumetric morphology of the MV apparatus. We have developed novel computational techniques for structural and fluid dynamic evaluation to determine cardiac valve pathophysiology. The combination of 3-D echocardiography and our computational simulation techniques can provide a powerful tool to evaluate complex structural and functional information of the MV apparatus. The team for the proposed project has demonstrated capability in computational modeling of valve dynamics and in clinical echocardiographic studies to successfully complete the project. Our principal aim is to develop a novel computational technique combining 3-D echocardiography with finite element (FE) and fluid-structure interaction (FSI) analyses to evaluate the effects of MV morphology (normal vs. diseased valves, and pre- vs. post-repair) on MV function. To this end, we will; 1) develop an integrated modeling platform to create a virtual MV model from 3-D transesophageal echocardiography for computational simulation and analysis; 2) determine the consequences of geometric alterations of the MV complex by comparative dynamic FE evaluations on normal, diseased, and repaired MVs; and 3) employ a comprehensive, state-of-the-art 3-D FSI model to analyze both normal MV function and alterations in left ventricle fluid dynamics resulting from MV disease and repair. Our long term goals are to develop a diagnostic methodology combining imaging techniques and computational structural and fluid dynamic analyses methods that will provide precise patient-specific 3-D MV geometry as well as detailed information of normal MV function and alterations with valvular disease. Through focusing our studies in this direction, we will be able to transition our techniques and strategies into the clinical setting to allow investigators to quantitate the extent of disease-related functional alterations and restoration towards normal valvular function following MV repair.